Therapy of Hyperhomocysteinemia in Hemodialysis Patients: Effects of Folates and N-Acetylcysteine

详细信息    查看全文

• 作者：Aless ; ra F. Perna ; Eleonora Violetti ; Diana Lanza ; Immacolata Sepe ; Guido Bellinghieri ; Vincenzo Savica ; Domenico Santoro ; Ersilia Satta ; Giovanni Cirillo ; Antonio Lupo ; Cataldo Abaterusso ; Ilaria Raiola ; Paolino Raiola ; Salvatore Coppola ; Biagio Di Iorio ; Giuseppina Tirino ; Massimo Cirillo ; Diego Ingrosso ; Natale G. De Santo
• 刊名：Journal of Renal Nutrition
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：22
• 期：5
• 页码：507-514.e1
• 全文大小：419 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objective

Uremia represents a state where hyperhomocysteinemia is resistant to folate therapy, thus undermining intervention trials¡¯ efficacy. N-acetylcysteine (NAC), an antioxidant, in addition to folates (5-methyltetrahydrofolate, MTHF), was tested in a population of hemodialysis patients.

Design

The study is an open, parallel, intervention study.

Setting

Ambulatory chronic hemodialysis patients.

Subjects

Clinically stable chronic hemodialysis patients, on hemodialysis since more than 3 months, undergoing a folate washout. Control group on standard therapy (n = 50).

Intervention

One group was treated with intravenous MTHF (MTHF group, n = 48). A second group was represented by patients treated with MTHF, and, during the course of 10 hemodialysis sessions, NAC was administered intravenous (MTHF + NAC group, n = 47).

Main Outcome Measure

Plasma homocysteine measured before and after dialysis at the first and the last treatment.

Results

At the end of the study, there was a significant decrease in predialysis plasma homocysteine levels in the MTHF group and MTHF + NAC group, compared with the control group, but no significant difference between the MTHF group and MTHF + NAC group. A significant decrease in postdialysis plasma homocysteine levels in MTHF + NAC group (10.27 ¡À 0.94 ¦Ìmol/L, 95 % confidence interval: 8.37-12.17) compared with the MTHF group (16.23 ¡À 0.83, 95 % confidence interval: 14.55-17.90) was present. In the MTHF + NAC group, 64 % of patients reached a postdialysis homocysteine level <12 ¦Ìmol/L, compared with 19 % in the MTHF group and 16 % in the control group.

Conclusions

NAC therapy induces a significant additional decrease in homocysteine removal during dialysis. The advantage is limited to the time of administration.